Internationally, Beveridge-type health systems are considered unusually prone to dramatic ‘big bang’ reorganisations. However in the UK there is a perception that organisations cannot make significant changes to acute services, such as closing hospitals, because of public opposition. Given significant pressures for centralisation of acute services, the consistent unpopularity of such changes, and the requirement for healthcare organisations to involve the public in their decision-making, this research explores policy and practice for involving the public effectively in major service changes across the UK’s four health systems: England, Northern Ireland, Scotland and Wales. Dr Stewart argues that efforts towards healthcare transformation need to understand public involvement as an intrinsic part of change, rather than as a communications issue for implementation. Effective public involvement can help organisations to make positive, major changes to acute services, but costs time and money. In the current climate of financial crisis, organisations may be tempted to adopt less transparent approaches to change. These are, however, unlikely to be implemented without public (and political) support.

Dr Ellen Stewart, Chancellor’s Fellow in Social Studies of Health & Medicine, Usher Institute, University of Edinburgh. Ellen Stewart is a social scientist working at the intersection of medical sociology, health policy and public administration. She recently completed a Chief Scientist Office Postdoctoral Fellowship, and the research reported in this seminar is supported by a Health Foundation Policy Challenge Fund grant. Her monograph, Publics and their health systems: rethinking participation was published in 2016.